From what data can a facility determine the percentage they will be paid for a specific procedure?

The percentage a facility will be paid for a specific procedure is most accurately determined by established payer reimbursement rates. These rates represent the agreements made between healthcare providers and insurers regarding the payment for various services rendered. Each insurance company has its own reimbursement schedule that outlines the expected payment for different medical procedures, which can vary significantly based on factors such as the provider's contract with the insurance company, regional payment rates, and specific billing codes associated with the procedures.

In contrast, while the average length of a hospital stay, complexity of the procedure, and net average daily revenue provide valuable insights into operational efficiency, patient care, and overall financial performance, they do not directly dictate the reimbursement rate a facility will receive for specific procedures. Understanding the established payer reimbursement rates is crucial for accurate budgeting, financial forecasting, and revenue cycle management within healthcare facilities.